Pain Management via Smartphone App
By Jennifer Anderson
Patients can employ smartphone apps to help manage pain, track medication side effects, and monitor conditions.
Who would have thought individuals aged 65 and older comprise one of the nation’s largest groups of cell phone users? “It surprised me,” says Robert Jamison, PhD, a pain psychologist at Brigham and Women’s Hospital in Boston. He has developed a novel way to put elders’ phones to use, creating an app designed not only to reduce trips to the emergency department but also to provide a psychological boost for patients.
“When you have new symptoms and not a lot of support, you can get anxious and upset,” says Jamison, who also is a professor of anesthesia and psychiatry at Harvard Medical School. “With this app, they have reassurance someone’s tracking how they are doing and giving feedback. It makes a difference.”
The new app can be downloaded onto any smartphone. It then prompts the user to enter health care information, including pain level, mood, activity, medication, and side effects. Users also set goals for themselves, including those involving weight loss, better sleep, less pain, improved function, or walking for longer periods of time. “They can look back anytime and see if they reach their goals,” Jamison says. Then each day the user is prompted to answer five questions:
1. Rate your pain in the past 24 hours on a scale of 0 to 10, with 10 being the most intense pain.
2. Rate your sleep in the past 24 hours, with 10 being no sleep. Jamison explains that people who hurt often cannot get comfortable at night. “It’s the No. 1 complaint,” he says.
3. Rate how much pain has interfered with your activity level in the past 24 hours, with 10 being severe interference.
4. Rate your mood in the past 24 hours, with 10 being severely depressed, anxious, or irritable.
5. Rate changes in your pain levels in the past 24 hours. Jamison explains that a change in pain level of two numbers or more triggers a response from the clinic.
Jamison says the entire questionnaire is quick and easy, taking no more than five or 10 seconds per day to complete. Users can answer the questions as many times per day as they like.
On the receiving end, a bachelor’s-level research assistant tracks the incoming data on a screen that resembles a website. The data are collected in each patient’s electronic medical record and presented in graphic format.
Jamison acknowledges that hiring a research assistant to track patient data is not a typical expense for most physician practices and hospitals. But given the exploding costs of health care, he says changes are coming, and everyone in the industry needs to adapt.
Older adults comprise 10% of the population but consume 50% of all health care costs, he says, and increasingly insurance carriers are requiring hospitals to justify repeat treatments and services. In short, hospitals will need to demonstrate that they are doing everything they can to keep discharged patients from returning to the hospital, he says.
Treatment of the Future?
Because it’s unreasonable to expect physicians to track patients’ cell phone data on their own, given the hundreds of messages that can arrive daily, the research assistant position is critical. The tech-savvy assistant can not only track patients and relay messages to physicians when necessary but also help to keep patients out of the hospital and minimize the need to send a nurse to a patient’s home. “We can track how people are doing; they feel someone is watching them; and we’re watching expenses,” he says.
Users receive periodic messages in return, such as “Thanks for checking in” or “It’s good to know you’re doing better.”
If a user reports significantly worse pain, the information is passed on to his or her physician, and the physician can either respond directly to the patient or send a message that may tell the patient to change how he or she is taking medication or to visit the clinic. “We think this information is a lot more reliable than a physician simply asking, ‘How have you been since I saw you last?’” Jamison says.
The pain app has been in the planning stages for several years but still is in its infancy. A new study, expected to be completed next year, will involve recruiting and following 60 cancer and noncancer pain patients from Brigham and Women’s. Each must have a smartphone and must have been experiencing pain for at least three months.
The smartphone component is critical, Jamison says, referencing an earlier study that involved providing handheld electronic pain monitors to 20 patients and asking another 20 patients to keep track of their pain in a traditional paper diary.
Every time participants with the handheld devices logged on, they got a message stating, “Keep up the good work.” After a year of tracking, “We were surprised to see how compliant everyone was,” Jamison says of the digital group. Several participants reported daily on their pain and were reluctant to give back their devices at the end of the study.
Those keeping paper diaries were not nearly as compliant, giving up after six months, Jamison says. It was not enough for them to know the physician might take a couple of minutes to glance at his or her notes at an upcoming routine visit. “If people don’t feel like anyone’s paying attention, they’re going to stop doing it,” he says. “That’s the missing ingredient. If you feel someone’s watching and appreciates the fact that you’re providing information, there’s a tendency to keep doing it.”
Digital support is particularly important for patients who are isolated in their homes and feeling alone and in pain, Jamison says. “If they have some sense that they are communicating with someone and getting support, that can be beneficial in itself,” he says.
The pain app provides additional benefits such as providing articles and information on ways to improve sleep and mood, manage worry, maintain a healthy appetite, and eat healthfully as well as suggestions for exercise and physical activity.
The app also provides behavior strategies for patients to use on their own to cope with their experiences rather than rushing off to the clinic. For example, if a patient experiences a dramatic increase in pain, he or she would be instructed to use a relaxation strategy, apply some comfort measures, pace his or her activity, and challenge worried thoughts. “It’s like telemedicine,” Jamison says. “They learn ways to get through a flare-up or other problem without going to the doctor.”
There are other deficiencies in existing apps, he says. None offers everything that comes with Jamison’s app: an opportunity to set goals, strategies for managing pain and related conditions, daily prompts to rate pain, reminders to take medications and keep medical appointments, and a way to connect with a provider.
Jamison says he still needs to work out the details of his app at the Pain Center at Brigham and Women’s Hospital. Among other challenges, there is the potential for collecting information on high utilization patients, or those who see multiple physicians, require multiple tests, and frequently visit the clinic. “These people require and demand a lot of intervention,” he says.
There also are legal issues to consider. If someone reports a medical crisis via cell phone, who is really responsible? “There’s a user’s agreement that explains this is just advice and we’re not really responsible; but it’s still something we need to work on,” Jamison says.
Eventually, he foresees health care systems across the country offering similar technologies.
— Jennifer Anderson is a freelance health and science writer based in Falls Church, Virginia.